#OTalk Tuesday 20th August 2019. Do Occupational Therapist routinely assess clients menstrual cycle, it’s affect on functioning and ability to engagement in occupations?

This weeks Rachel @OT_rach from OTalk is hosting the chat this is what she has to say,

I have recently listened to an audiobook call ‘Period Power’ by Melissa Hill.

The introduction starts with the following.
In my profession as a woman’s health specialist I get asked a lot of questions, questions that my clients have had since they were 13 that they still don’t have an answer for in their 30s. Questions that usually begin with why, such as

Why is my period so painful/short/light/long/heavy?
Why are they so frequent/irregular/rare?
Why have they stopped altogether?
Why do I feel so great one week and so bloody awful the next?
Why is my vagina sore dry/wet/sensitive?
Why does sex hurt sometimes/all the time?
Why don’t I want to have sex?
Why am I so horny?
Why am I so goddamn tired all the time?
Why do I get so bloated that my dress size jumps up two sizes?
Why do I feel anxious/stressed/depressed?
Why am I so full of rage.
The answer to all of these questions is it’s your hormones. ‘

In another chapter she goes on to describe.

Follicular Phase: Menstruation to Ovulation.
Your period and your cycle are a reflection of your overall health and can be affected by little and large life events. Those gallons of wine and platefuls of delicious stinky cheesy cheese you devoured over Christmas, the crazy work project that nearly broke you, the relationship issues that keep you up all night, the death of a loved one, weight gain or loss, travelling, finally quitting smoking, the supplements you been taking, the Yoga class you’ve been going to, the new job that you love, the great sex you’ve been having, – they all have an impact on whether your period is early or late, light or heavy, short or long and painful or pleasurable.

Period Power – Maisie Gill Greentree 2019

What struck me as I listen to this book was how a lot of what she described were occupations that we engage in, and it got me thinking, Do Occupational Therapists routinely assess clients menstrual cycle, it’s affect on functioning and ability to engage in occupations they need to or want to do?

As I listened I tweeted out some of my thinking, got some great responses and had some interesting discussions from the OT community. Including Katie Major @KatieCMajor, who kindly agree to co host this chat.

Below are some questions that I plan to ask during the chat on Tuesday to generate discussion.

Question 1) Do you routinely ask about, assess for or provide interventions relating to your clients menstrual cycle? If so please give examples.

Question 2) From your own experiences of having a menstrual cycle or from knowing someone that does, what impact does it have on engagement in occupations that you need to or want to do?

Question 3) What assessment tools could we use as occupational therapist to understand the impact a clients menstrual cycles may be having on their functioning?

Question 4) What are the possible interventions we could engage our clients in to enable them to manage the occupation of their dealing with their period?

Question 5) What are the possible interventions we could work on with clients to enable them to manage and understand the impact of the menstrual cycle on their ability to engage in occupations?

Loving forward to the chat, Rachel



#OTalk 13th August 2019 – Breaking the silence: involuntary childlessness in the occupational dark shadows

Alice Hortop @LaughingOT Senior Occupational Therapy Lecturer The University of the West of England (UWE Bristol) is hosting the weeks OTalk, here’s what she had to say.

According to the NHS (2017), 1 in 7 UK couples have trouble in conceiving a child. The charity Fertility Network UK (2019) disputes the NHS figure as an underestimation and proposes a more realistic figure is 1 in 6, equating to infertility affecting 3.5 million people in the UK. The World Health Organisation (WHO, 2019) state that female infertility is graded the 5th greatest, serious global disability in populations under 60. They describe infertility as a disease, a medical condition and disability, which means access to healthcare in relation to infertility, sits under the ‘Convention of the Rights of Persons with Disability’. In addition, Schmidt (2010) refers to infertility as a ‘social situation’; moving beyond the WHO medicalised definition. Childlessness is a major life theme deemed as a chronic stressor associated with low control and long lasting negative social and psychological consequences (Schmidt, 2010). Zandi et al (2017) support the need for health care to treat infertility broadly beyond the ‘mere’ individual and biological dysfunction.

Child bearing is an expected transition into adulthood both socially and politically, imperative to humankind survival. For many the failed aspiration to establish a family is an intense, recurring, chronic sorrow for an intangible loss (Tufford, 2009). Involuntary childlessness associates with emotional problems with higher depression scores over a 2-year period with a greater tendency towards catastrophizing. Both men and women reveal higher levels of depressive symptoms, women report highest levels (Kraaij, Garnefski and Vlietstra, 2008). 42% of people experiencing infertility describe feeling suicidal with 90% sharing feeling of depression and describing their experiences as traumatic (Fertility Network UK, 2019). People try to access parenthood through alternative means such as adoption reported higher depressive symptoms than those who chose not to.

In order to understand the lived experience of people who are involuntarily childless it is useful to identify if there is a shared understanding of their needs by health professionals. If their needs are understood and further addressed appropriately. Half of 129 gynaecologists interviewed recommended offering psychological counselling to clients following unsuccessful fertility treatment (Wischmann, 2007). The majority (90%) of women in a post fertility treatment follow up survey felt psychological counselling ought to be offered, particularly at the point of stopping treatment (Hammarberg et al, 2001). Health professionals demonstrate a significant underestimation of psychological need and the timing of its delivery. Psychological counselling and infertility treatments dominate literature for the intervention options in health and social care. The author’s experience of failing to access IVF, fostering and adoption did not include any signposting or offers of talking therapies, even when actively sought. If the lived experience of childless people was more fully understood would signposting to charities such as Fertility Network UK be more prevalent. Fertility Network UK offer a support line, support groups and a downloadable ‘More to life’ self-help guide.

This section examines if the research is relevant to occupational therapists and if so how. Occupational therapists are concerned with the occupations that people engage with, the influence of occupations on their identity and their roles in their lives. Being unable to experience being a mother or father may influence the variety of occupations engaged with, the roles played in the individual’s life and occupational identity. Twinley (2013) discusses the dark side of occupation, advocating occupational therapists need to understand occupations in the shadows. Twinley (2013) suggests historically occupational therapists focussed on the positive influences of occupations on health and wellbeing. The background literature indicates involuntary childlessness strongly associates with grief, alienation and loss. She argues a need for exploration into occupations not considered beneficial for health and wellbeing, that if understood would enable working effectively with diverse populations. Or in this case occupations associated with parenthood that are missing that need to be understood to realise their effect on health and wellbeing. This begins with understanding the lived experience of people who are involuntarily childless.

The host hopes to share insights into the lived experience of involuntary childlessness on people’s roles, occupational identity and occupational engagement. The profession needs to consider their role in addressing childlessness in their interactions, therapeutically and practically.

Post chat updates:

Online transcript Healthcare Hashtags Transcript

PDF Transcript #OTalk Healthcare Social Media Transcript August 13th 2019

The Numbers


#OTalk Participants


Davidson, S. (2016) Factsheet: Employment Issues [online] available at: http://fertilitynetworkuk.org/wp-content/uploads/2019/02/Employment-Issues.pdf (accessed on 02/03/2019)

Hammarberg, K., Astbury, J. and Baker, H. (2001) Women’s experience of IVF: a follow-up study. Human Reproduction, 16, pp 374-383

Kraaij, V. Garnefski, N. and Vlietstra, A. (2008) Cognitive coping and depressive symptoms in definitive infertility: A prospective study. Journal of Psychosomatic Obstetrics and Gynecology, 29 (1) pp 9 -16

NHS (2017) Overview infertility. [online] available at: https://www.nhs.uk/conditions/Infertility/ (accessed 6/10/2018)

Schmidt, L. (2010) Psychological consequences of infertility and treatment. In: Carrell, D. and Peterson, M. (eds) Reproductive Endocrinology and Infertility. Switzerland: SpringerLink pp 93-100.

Tufford, L. (2009) Healing the pain of infertility through poetry, Journal of Poetry Therapy, 22 (1), pp 1-9

Twinley, R. (2013) The dark side of occupation: A concept for consideration. Australian Occupational Therapy Journal, 60, pp 301-303

Wischmann, T., (2009) Implications of psychosocial support in infertility-a critical appraisal. Journal of Psychosomatic Obstetrics and Gynecology, 29 (2), pp 83-90

Zandi, M., Mohammadi, E., Vanaki, Z., Shiva, M., Lankarani, N. and Zarei, F. (2017) Confronting infertility in Iranina clients: a grounded theory. Human Fertility, 20 (4), pp 236-247

#OTalk Research Tuesday 6th August at 8pm

Host: Chloe Kitto Specialist Occupational Therapist  RNOH Pain Rehab  UCL Hon Lecturer ‪@chloe_kitto ‬

I am excited for the opportunity to lead the #OTalk Research discussion for August.  This September, I am embarking on a clinical research pathway and when it comes to designing my project, I am determined to keep an occupation-based approach.  Why?  The article below, written eight years ago by Robinson et al inspired, challenged and concerned me.  Here is an excerpt –

“Descriptions of contemporary occupational therapy practice largely do not reflect the use of occupation as both ends and means. These gaps must be addressed if future practice is to embrace an occupational perspective of health. Occupational therapists urgently need to generate evidence of the efficacy of occupation-based interventions for people [with chronic pain] and become experts in using evidence to support practice. This article is a red flag to the profession; if occupational therapists do not act quickly to address the limitations of current practice, other professional groups will continue to develop expertise in the use of activity. If occupational therapists complacently continue to practice without attention to their professional domain, the

opportunities to develop occupational therapy in line with the occupational needs of people [with chronic pain] will eventually no longer exist.”

This article focuses on the role of OT within a chronic pain population (which is my field); however, I suspect the message has a wider application.  The caution that the authors pose – that other professions will continue to develop in the use of activity – is now very much a reality in chronic pain.  So much so that most pain management programmes in this country do not employ OTs, and physiotherapists, nurses, and psychologists are upskilling quickly to provide functional interventions.  This is a strong factor which has influenced me to pursue research now in my career.  How can I (we) be confident that OT research projects maintain an occupation-based focus?

I am interested in exploring with the #OTalk community the concept of occupation-based research by asking the following:

1. In your view, what is occupation-based research?

2. In your view, what is NOT occupation-based research?

3. What makes this distinction challenging?

4. Is it important that OT research be occupation-focused? Why?

5. How do we make occupation-based research interesting to the wider health world?

6. What key occupations need a research spotlight on them?

I am happy to continue networking with other OTs who are interested in occupation-based research – chloe.kitto@nhs.net

Thank you all for your interest and I look forward to discussing this topic with you next Tuesday evening.

Reference Robinson, K., Kennedy, N., & Harmon, D. (2011). The Issue Is—Is occupational therapy adequately meeting the needs of people with chronic pain? American Journal of Occupational Therapy, 65, 106–113.

Post Chat

Host: Chloe Kitto @chloe_kitto

Support on the OTalk account: Nikki Daniels @NikkiDanielsOT

Online Transcript

#OTalk Transcript August 6th 2019

The Numbers

1.033M Impressions
191 Tweets
21 Participants
153 Avg Tweets/Hour
9Avg Tweets/Participant

#OTalk Participants

#OTalk Tuesday 30th July – Occupation v’s Activity? Intervention of doing v’s Diversion of doing. Is Occupational Therapy misunderstood and how do we counteract this?

This week one our own @OT_rach will be hosting the chat

Occupational therapy can often be difficult to describe to others. One reason for this might be some of the language we use to describe the interventions we undertake, words like occupation and activity can have different meanings to different people and other professionals.

We are sometimes challenged by what people see us doing, for example engaging people in activities. To others the reasons why this activity has been chosen, might be misunderstood or not understood in the first place. Also there is limited recommendations within NICE Guidelines and government white papers that describe the level of occupational therapy expected and how this should be delivered.

In my experience in working within acute mental health wards. There is often a presumption we are there to engage and entertain patients rather than deliver therapy. For me this is an ongoing battle as a recent CQC, report stated service users did not have enough to do, this was seen as the occupational therapist role and responsibility by the organisation I work for, and we were asked to offer activity for more hours than we currently do.

Those that work in physical settings can often be seen as discharge facilitators, perhaps not completing a comprehensive occupational therapy assessment due to the restraints and expectations of the organisation they work for.

The above are just examples of my experience but the questions below aim to provoke discussion during the chat to hopefully generate ideas on how we improve understanding of Occupational Therapy to our colleagues, organisations and service users.

Question 1) How do you describe occupational therapy to your colleagues, service users and organisations?

Question 2) What is the difference between occupation and activity?

Question 3) Have you come across a lack of understanding of what occupational therapy is? If so please give examples?

Question 4) What resources have you used to explain Occupational Therapy better to your patients, colleagues and organisations?

Question 5) What more could be done to ensure that organisations understand the role of occupational therapists?

Looking forward to the chat see you Tuesday 8pm on twitter.



Nice Guidance -Mental wellbeing in over 65s: occupational therapy and physical activity interventions Public health guideline Published: 22 October 2008 nice.org.uk/guidance/ph16

Nice Guidance- Parkinson’s disease Quality standard Published: 9 February 2018 www.nice.org.uk/guidance/qs164



Online Transcript

#OTalk Transcript July 30th 2019

The Numbers

2.448M Impressions
489 Tweets
86 Participants
39 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants

#OTalk 23rd July 2019 An exploration of the application of the Vona du Toit Model of Creative Ability (VdTMoCA) in contemporary Occupational Therapy practice: the challenges, the positives, service developments, advances in practice, the future.

This weeks OTalk will be hosted by Tori Wolfendale, MSc, BSc (Hons) Research Director for the VdT Model of Creative Ability Foundation (UK) and Lead Occupational Therapist in the Secure Division at Mersey Care NHS Foundation Trust. Tori’s role within the foundation involves supporting the engagement in research activities on the Vona du Toit Model of Creative Ability (VdTMoCA).

What is the Vona du Toit Model of Creative Ability?

The VdTMoCA is an Occupational Therapy practice model originating from South Africa.  The model as presented by de Witt (2005, 2014), is founded upon the theory of creative ability developed by Vona du Toit (Occupational Therapist) in the 1960s and early 1970s.  The term ‘creative’ does not refer to artistic flair but to one’s ability to bring into existence something that did not exist before – one’s ability to bring about change within oneself and in one’s world.

The model has a developmental frame of reference combined with existentialism, phenomenology and motivation theory.  The central belief is that volition and motivation govern action and action is the manifestation or expression of motivation. Volition, motivation and action are inextricably linked, and therefore one can identify an individual’s motivation by observing the person’s action.

The model describes stages or levels of creative ability – that is, levels of volition, motivation and corresponding action (behaviours and skills – occupational performance).  These levels are sequential and there can be progression and regression through the levels. Vona du Toit believed that human beings progress through developmental levels of behaviour and skill development and are motivated to develop these in a sequential sequence. That is, we are motivated to develop a variety of skills as environmental/social/relationship/occupational demands change and influence us throughout the lifespan.  In the event of illness, trauma, injury or in response to changing life demands, we can regress to a lower level of ability.  This is recognisable in clients that prior to developing a mental illness were ‘high functioning’ or living effective daily lives.  However, with the onset of a psychotic or other illness, appear to be functioning at a lower level than previously.  For people with dementia, a continuing regression through the levels is evident.  Creative ability develops in relation to four occupational performance areas: social ability, personal management, work ability and use of free time.

What service user population can the Vona du Toit Model of Creative Ability be used with?

The model can be used with any diagnosis and severity of illness or trauma.  The model is recovery and ability focused – therefore, it seeks to identify and develop existing ability rather than identify dysfunction or deficit. In the UK, the model is used in mental health and learning disabilities services, with a significant rise in forensic mental health and learning disabilities during the last four years (VdTMoCAFoundation UK, 2013, 2016). 

How can the Vona du Toit Model of Creative Ability inform practice?

The model provides a means of performing an assessment to identify the level of creative ability and the phase of the level.  In addition, the model uniquely provides a detailed guide to treatment/intervention for the selection and use of activity, the environment and the therapeutic use of self in order to provide the ‘just right challenge’ for growth through effort in activity participation.  This guide brings together the core occupational therapy skills and enables therapists to use activity as a powerful therapeutic tool i.e. provide occupational therapy.

In the UK, the VdTMoCA is particularly valued for enabling Occupational Therapists and support workers to understand clients who are significantly limited in motivation and occupational performance and are difficult to engage and provide effective therapy for (VdTMoCA Foundation UK, 2013, 2016; Hosier et al. 2011).  Subsequently, the use of the model’s intervention guide has improved client engagement in therapy (Harvey & Fuller 2009; VdTMoCA Foundation UK, 2013, 2016; Wilson & White, 2011).  The model is also valued for improving Occupational Therapists’ and Occupational Therapy students’ confidence in their clinical reasoning (VdTMoCA Foundation UK, 2013, 2016; promoting Occupational Therapy professional language and identity (VdTMoCA Foundation UK, 2013, 2016); increasing MDT understanding of Occupational Therapy and its value to services, and improving therapists’ confidence and job satisfaction (Wilson & White 2011).

Question during the chat will include.

Q1) What is your experience of using the Vona du Toit Model of Creative Ability in practice? Please specify what area of practice you are currently working in. #OTalk #VdTMOCA

Q2) In your experience, what have been the barriers/challenges to implementing the Vona du Toit Model of Creative Ability in your practice #VdTMoCA? How have you overcome this? What strategies did you utilise? #OTalk.

Q3) How do you think the implementation of the Vona du Toit Model of Creative Ability has changed your practice? Think around assessment, developing treatment, evidencing effectiveness of 1:1/Group interventions, report writing, service user engagement, profile of the #OccupationalTherapy profession. #OTalk #VdTMOCA

Q4) What have been your particular highlights since implementing the Vona du Toit Model of Creative Ability into your practice? Please share your experiences on what has worked well, best practices! #OTalk #VdTMOCA

Q5) Has treatment been effective since you have implemented the Vona du Toit Model of Creative Ability? If so, how have you evidenced this? How have you shared with within your service user/service/clinical team? #OTalk #VdTMOCA

Q6) How useful is the #VdTMoCA when making decisions on clinical intervention? #OTalk #VdTMOCA

Q7) Next Steps: What are your future plans around the use of the Vona du Toit Model of Creative Ability? Think in terms of your service, research, quality improvement projects, training needs. We would love to hear from you, particularly around plans to contribute to the evidence base for the #VdTMOCA.


de Witt, P. (2005). Creative ability: a model for psychosocial occupational therapy IN R Crouch and V Alers (2005) Occupational Therapy in Psychiatry and Mental Health. 4th edition. London: Whurr Publishers Limited

de Witt, P. (2014). Creative ability: a model for individual and group therapy for clients with psychosocial dysfunction IN R Crouch, V Alers (2014). Occupational Therapy in Psychiatry and Mental Health. 5th edition. London: Wiley Publishers.

Harvey H, Fuller K. (2009). Changing practice through MoCA. OT News, Dec, p41.

Vona du Toit Model of Creative Ability Foundation. (UK) (2013). Perspectives of the Vona du Toit Model of Creative Ability: a survey of occupational therapists and occupational therapy support workers. Vona du Toit Model of Creative Ability Foundation (UK).

Vona du Toit Model of Creative Ability Foundation. (UK) (VdTMoCAF (UK)) (2016). Gaining Momentum: The VdTMoCA Foundation (UK) Research Strategy 2016-2021. Northampton: Vona du Toit Model of Creative Ability Foundation (UK).  Available at: http://www.vdtmocafuk.com/assets/images/documents/gaining_momentum/Gaining_Momentum_VdTMoCAF_Research_Strategy.pdf (accessed on 08/07/2019).

Wilson S, White B. (2011). The journey to service redesign. OT News, August, p36-37.


HOSTTori Wolfendale, MSc, BSc (Hons) Research Director for the VdT Model of Creative Ability Foundation (UK) @VdTMoCAFUK


Online Transcript

#OTalk Transcript July 23rd 2019

The Numbers

697.581K Impressions
193 Tweets
19 Participants
154 Avg Tweets/Hour
10 Avg Tweets/Participant

#OTalk Participants

#OTalk 16th July – The Role of occupational therapy in safeguarding

This week Sophie Grantham @OTSophie will be hosting the chat, here is what she has to say. 

In light of recent experience in my own work setting of increased occupational therapy input in safeguarding enquiries, I felt an OTalk about the topic may help develop my own knowledge, as well as find out more about what is going on in other Occupational Therapy settings.

Safeguarding is a term used in the UK to denote measures to protect the health, wellbeing and human rights of individuals, which allow people to live free from abuse, harm and neglect (Care Act, 2014).

Safeguarding offers a framework used to put appropriate measures in to place to protect people, but if this is the case, why do we as therapists not view it quite in the same way?

Whilst our Social Work colleagues have always been involved in safeguarding, it is something Occupational Therapists appears to be increasingly involved in, and with this in mind, how can we do this, whilst keeping our Occupational values at the core?

This OTalk therefore plans to explore this topic, with the aim of learning from each other.


-What is your current involvement with safeguarding? (any? Explain).

-How do safeguardings affect current practice?

-Do you feel safeguarding should be part of the Occupational Therapy role, why?

-What systems (if any) are in place currently for you to prevent safeguardings?

-How can we as Occupational Therapist’s positively prevent safeguardings?

Post Chat

Host: Sophie Grantham @OTSophie

OTalk Support: Carolina @colourful_ot

Online Transcript

#OTalk Healthcare Social Media Transcript July 16th 2019

The Numbers

1.281M Impressions
253 Tweets
22 Participants
202 Avg Tweets/Hour
12 Avg Tweets/Participant

#OTalk Participants

Data for #OTalk can be up to 15 minutes delayed

#OTalk 9thJuly – Age Appropriate Occupations

This weeks #OTalk is on the topic of “Age Appropriate Occupations” and will be hosted by Kirstie Hughes (@Kirstie_OT).

Over the years when I have told people I enjoy building Lego I am met with responses such as “but its for Kids” or “Really, why?” and my answer is always why not?!

At this years Royal College of Occupational Therapist Annual Conference I presented an occupation station to share my love of Lego. I was hugely overwhelmed by demand for my session and the positive feedback with one attendee commenting on how he felt calm and relaxed engaging in occupational flow amongst the busy few days of conference

The queries have often left me thinking about age appropriate occupations in Occupational Therapy and the wider Health and Social Care context. Activities such as Easter bonnet making in residential homes, nursery rhymes in Learning Disabilities and Coloring in mental health services were often looked upon as “not appropriate”. As research in these areas have progressed we have an evidence base for their benefits to health and well being and they are now seen as mainstream activities, but why were they ever seen as inappropriate in the first place?

This chat aims to encourage discussion around age appropriate occupations, what impacts on them and why we stop engaging within adulthood.

Some questions to consider;

1: Do you engage with or participate in any occupations that may not be deemed as “age appropriate”? In addition to Lego building I also play PokemonGo.

2: What was your favourite occupation as a child? What did you gain from it? Do you still participate in it now? If not why not?

3: As OTs we know the importance of meaning in occupation, so does age really matter to us?

4: Is the need to provide a group activity impacting on the options available to us? Does catering for the many reduce meaningful options?

5: Are there any types of occupation based activities you would like to try within your service but have concerns around justifying them? Maybe you have tried some and was successful in your clinical reasoning?

6: Are the any new occupations you would like to try as an adult? Why barriers are there to your participation?

Post Chat

Host and On OTalk Account; @kirstieot

Online Transcript

#OTalk Healthcare Social Media Transcript July 9th 2019

The Numbers

2.351M Impressions
336 Tweets
36 Participants
269 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants